By June Fabre, RN, MBA
Every organization has structure, but not all organizations have bureaucracy.
We need structure to work efficiently and serve patients. But, structure should be our tool, not our master.
Structure that becomes our master turns into bureaucracy.
Bureaucracy has no brain. Only your dedicated staff members can use their brains for the critical thinking needed to solve organizational problems.
What happens when structure turns into bureaucracy and becomes our master?
Money is lost because bureaucracy is expensive!
Motivated staff become disillusioned!
Mistakes become rampant!
Suppose that your critically thinking nurses notice safety problems but lack the autonomy to eliminate them due to a safety committee with a slow response.
This bureaucratic bottleneck wastes time, frustrates the nurses, and eventually injures patients.
This month’s best practice illustrates that it is quality that defines success, and that large provider groups aren’t necessarily better.
Research: What do nurses need?
The Harvard researchers highlighted in my most recent Smart Nursing book made the following recommendations about enabling nurses to solve the root causes of potential errors.
First, if workers are to engage in root cause removal, this activity must be an explicit part of their job and enough time allocated for removal efforts.
Second, there needs to be frequent opportunities for communicating about problems with individuals who are responsible for supplying frontline workers with materials or information . . . There must be convenient opportunities in the course of the day for workers to give feedback.
Third, when the signal is given that there is a problem, proper attention must be paid to it. We must recognize communication as a valid step in the direction of improvement.
Often the best that the worker could do was to merely raise the issue, but too often this worker ran the risk of being considered a “complainer.” We did not observe any instances where the nurse contacted someone about a trivial or insignificant exception. In fact, we observed several occasions where we were surprised that the nurse did not raise awareness around a problem that we felt could have serious consequences. (Fabre, J, (2009) Smart Nursing-Nurse retention and patient safety improvement strategies, Second edition, New York: Springer, p. 109.
When the structures that support the work nurses do include elements of nurse engagement, communication opportunities, and responsive leadership, there will be an exciting increase in motivation, safety and cost effectiveness!
Nurse Retention & Patient Safety Improvement Strategies, Second Edition
June Fabre, MBA, RNC
www.amazon.com (free shipping)